Provider Demographics
NPI:1679972046
Name:STAFFORD-LEWIS, LUCINDA K (LMFT)
Entity Type:Individual
Prefix:MS
First Name:LUCINDA
Middle Name:K
Last Name:STAFFORD-LEWIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 N. EL CAMINO REAL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672
Mailing Address - Country:US
Mailing Address - Phone:949-291-2915
Mailing Address - Fax:
Practice Address - Street 1:1401 N EL CAMINO REAL
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-4985
Practice Address - Country:US
Practice Address - Phone:949-291-2915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51935106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist